title: Predictors of prolonged length of intensive care unit stay after stage I palliation: a report from the National Pediatric Cardiology Quality Improvement Collaborative.
abstract: The objective of this study is to identify predictors of prolonged intensive care unit (ICU) length of stay (LOS) for single ventricle patients following Stage I palliation. We hypothesize that peri-operative factors contribute to prolonged ICU stay among children with hypoplastic left heart syndrome (HLHS) and its variants. In 2008, as a part of the Joint Council on Congenital Heart Disease initiative, the National Pediatric Cardiology-Quality Improvement Collaborative established a data registry for patients with HLHS and its variants undergoing staged palliation. Between July 2008 and August 2011, 33 sites across the United States submitted discharge data essential to this analysis. Data describing the patients, their procedures, and their hospital experience were entered. LOS estimates were generated. Prolonged LOS in the ICU was defined as stay greater than or equal to 26 days (i.e., 75th percentile). Statistical analyses were carried out to identify pre-operative, operative, and post-operative predictors of prolonged LOS in the ICU. The number of patients with complete discharge data was 303, and these subjects were included in the analysis. Univariate and multivariate analyses were performed. Multivariate analysis revealed that lower number of enrolled participants (e.g., 1-10) per site, the presence of pre-operative acidosis, increased circulatory arrest time, the occurrence of a central line infection, and the development of respiratory insufficiency requiring re-intubation were associated with prolonged LOS in the ICU. Prolonged LOS in the ICU following Stage I palliation in patients with HLHS and HLHS variant anatomy is associated with site enrollment, circulatory arrest time, pre-operative acidosis, and some post-operative complications, including central line infection and re-intubation. Further study of these associations may reveal strategies for reducing LOS in the ICU following the Norwood and Norwood-variant surgeries.
authors.affiliation: University of Maryland School of Medicine, Baltimore, MD, USA, cbaker-smith@peds.umaryland.edu.
authors.forename: Carissa M
authors.initials: CM
authors.lastname: Baker-Smith
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Wilhelm
authors.forename: Steven R
authors.initials: SR
authors.lastname: Neish
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Klitzner
authors.forename: Robert H
authors.initials: RH
authors.lastname: Beekman
authors.forename: John D
authors.initials: JD
authors.lastname: Kugler
authors.forename: Gerard R
authors.initials: GR
authors.lastname: Martin
authors.forename: Carole
authors.initials: C
authors.lastname: Lannon
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Jenkins
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Rosenthal
mesh_terms: D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D058327:Norwood Procedures; D010166:Palliative Care; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D058996:Quality Improvement; D012042:Registries